Search news

News

Chair of the national maternity review announced

Baroness Julia Cumberlege is to lead a major review of maternity services which is set to modernise care for women and babies across the country, NHS England announced today.

The programme of work will assess current maternity care provision and consider how services should be developed to meet the changing needs of women and babies.

The review was promised in the NHS Five Year Forward View and its terms of reference were published just after the report into maternity care at University Hospitals of Morecambe Bay NHS Foundation Trust was published earlier this month.

Baroness Cumberlege said: “NHS England recognises just how important the experience of childbirth is to women, their partners and the new born child. Though the majority find the care they receive to be good, this is a chance to raise standards of safety, to innovate and to explore how maternity services can best meet the needs of today.

“I see this review as an opportunity for parents to shape the services they want professionals to deliver. The team will travel widely in England to listen and to seek out and assess innovative models of care here and abroad.

“Shortly we will let you know how you can help. I will welcome the ideas of parents and professionals alike.”

Simon Stevens, Chief Executive of NHS England, said: “Having a baby can be one of the most joyous experiences you can go through and we know that the vast majority of women are happy with the maternity care they receive. But we also know great care isn’t everywhere. The time is right to take stock, and consider how we can best deliver maternity care safely in every part of the country, while better meeting the high expectations women and their families rightly have.

“Under Julia’s leadership, we need this review to independently assess the evidence – from this country and overseas – on how we can improve care for women, babies and their families.”

Baroness Cumberlege brings a wealth of experience in healthcare leadership. She is Honorary Fellow at several Royal Colleges including the Royal College of Obstetrics and Gynaecologists. She chaired working parties for the Royal College of Physicians – which led to the ‘Doctors in Society’ (2005) and ‘Future Physicians: Changing Doctors in a Changing World’ (2010) reports. She is a patron of the National Childbirth Trust and Vice President of the Royal College of Midwives. In the 1990s she also led a major review on maternity care, producing the ‘Changing Childbirth’ report for the Department of Health.

She will work closely with other members of the review team and provide independent leadership for its overall work, which will include:

reviewing the UK and international evidence and making recommendations on safe and efficient models of maternity services, including midwife-led units;

ensuring that the NHS supports and enables women to make safe and appropriate choices of maternity care for them and their babies; and

supporting NHS staff, including midwives to provide responsive care.

A full list of members will be confirmed soon. They include:

Sir Cyril Chantler (Vice Chair)

Professor Cathy Warwick, Royal College of Midwives, Chief Executive

Dr David Richmond, Royal College of Obstetricians and Gynaecologists, President

The review team will establish a number of advisory groups covering the healthcare system, the voluntary sector and international models of care. They will also engage with NHS Citizen networks on the ideas and solutions they have for improving maternity care.

The review team will report its findings by the end of the year.

Topics

9 comments

The review is very much welcomed. However, I hope that when the panel ‘ makes recommendations on safe and efficient models of maternity services, including midwife-led units’ they will look at the quality of evidence on which they are being told midwifery led units are safe. The Birth place study was rated of low quality by NICE despite costing some £13 million. It was a key driver for the subsequent NICE Intrapartum guideline’s recommendations. It showed a doubling of adverse outcomes for babies born to first time mothers when the researchers compared ‘apples with apples’ i.e. matched the populations properly by excluding those with problems at the start of labour. Only when the bizarre results from the small minority of errant units who returned less than 85% of their records were included, could you agree with the study’s conclusion that freestanding midwifery units are safe for first time mothers. There is much politics, little science, poor use of statistics and many vested interests in the maternity policies that currently prevent women accessing the best information and care the NHS can afford. The ideology of the Muskateers is deeply entrenched and I fear extends far higher up the chain of command than the wards of Morecambe bay; something for which we have files of evidence we could share. I wish the Review team every success but they will need great courage and determination to call for the changes that are really necessary.

Thelatest NICE guidance makes clear that births in midwifeled units (both freestanding and alongside consultant led obstetric units) and homebirths can be as safe, for low risk pregnancies, as those in consultant led obstetric units, and that these result in less intervention.

This is untrue. The research shows that consultant led obstetric units are the least safe option for fit and healthy women and babies, and we should stop misleading women and tell them the truth.

It is true that births in freestanding and alongside midwifery units and home birth result in less intervention. We should not be conflating these two facts.

I agree very much with the comments by Dr McDonald and support her recommendation that perinatal mental health must be included in this review.
Also see http://everyonesbusiness.org.uk/ for the reports by the Maternal Mental Health Alliance and others of how vital this is. I speak and write as a former sufferer of puerperal psychosis and continue to campaign for the need for perinatal mental health to be an essential part of maternity care.

I am interested to see that there is no GP representative on the Maternity Review. GPs are important members of the team in maternity care (see Confidential Enquiry into Maternal Deaths) and they are the health professionals mainly responsible for the maternal postnatal check. There has been discussion recently about this check, raised by a survey carried out by NCT/Netmums, showing that this check may not be fit for purpose. It is also clear that the funding for this check is not accounted for in the GP Contract with NHS England.

I would be grateful if these issues could be addressed by the review

Dr Liz McDonald, Chair of Perinatal Faculty, Royal College of Psychiatristssays:

Maternal mental health is a major issue for women in the perinatal period. I understand that mental health will be thought about and looked at within the maternity review. Is someone being appointed to the panel to ensure that mental health is thought about in a coherent and knowledgable way? The lack of parity between physical and mental health care in the perinatal period remains a huge source of inequity.

I read a few months ago about the scandalous post code lottery of still births in England – and hope this enquiry will prove seminal in significantly reducing avoidable still births and all the distress that comes with the loss of a baby in such circumstances.

I looked into a few references on this topic and they are listed below.

The National Patient Safety Agency are delighted to confirm the review panel for the Maternal and Newborn Health Clinical Outcome Review by ans Expert Panel chaired by Dr Sheila Shribman, National Clinical Director for Children, Young People and Maternity Services, Department of Health. May 2011 – What resulted from this? What action plans? what demonstrable service improvements?

I am delighted the Review is to take place and even more delighted that Baroness Cumberlege is to chair the Review.
I hope very much that the Practice of Supervision of Midwives is revisited and a system that is mandatory if not by the Regulatory body the NMC
Audrey Emerton